title: Multicentre audit of inpatient management of acute exacerbations of chronic obstructive pulmonary disease: comparison with clinical guidelines.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) exacerbations are a major cause of hospital admission and clinical guidelines for optimised management are available. However, few data assessing concordance with these guidelines are available. We aimed to identify gaps and document variability in clinical practices for COPD admissions.
  
  
  METHODS
  Medical records of all admissions over a 3-month period as COPD with non-catastrophic or severe comorbidities or complications at eight acute-care hospitals within the Hunter New England region were retrospectively audited.
  
  
  RESULTS
  Mean (SD) length of stay was 6.3 (6.1) days for 221 admissions with mean age of 71 (10), 53% female and 34% current smokers. Spirometry was performed in 34% of admissions with a wide inter-hospital range (4-58%, P < 0.0001): mean FEV1 was 36% (18) predicted. Arterial blood gases were performed on admission in 54% of cases (range 0-85%, P < 0.0001). Parenteral steroids were used in 82% of admissions, antibiotics in 87% and oxygen therapy during admission in 79% (with oxygen prescription in only 3% of these). Bronchodilator therapy was converted from nebuliser to an inhaler device in 51% of cases early in admission at 1.6 (1.7) days. Only 22% of patients were referred to pulmonary rehabilitation (inter-hospital range of 0-50%, P = 0.002). Re-admission within 28 days was higher in rural hospitals compared with metropolitan (27% vs 7%, P < 0.0001).
  
  
  CONCLUSIONS
  We identified gaps in best practice service provision associated with wide inter-hospital variations, indicating disparity in access to services throughout the region.
authors.affiliation: Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia. jeff.pretto@hnehealth.nsw.gov.au
authors.forename: J J
authors.initials: JJ
authors.lastname: Pretto
authors.forename: V M
authors.initials: VM
authors.lastname: McDonald
authors.forename: P A B
authors.initials: PA
authors.lastname: Wark
authors.forename: M J
authors.initials: MJ
authors.lastname: Hensley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009511:New England; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012189:Retrospective Studies; D013147:Spirometry; D016896:Treatment Outcome